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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Beek M, Gobardhan P, Klompenhouwer E, Menke-Pluijmer M, Steenvoorde P, Merkus J, Rutten H, Voogd A, Luiten E. A patient- and assessor-blinded randomized controlled trial of axillary reverse mapping (ARM) in patients with early breast cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brandsma HT, Hansson BME, Aufenacker TJ, van Geldere D, van Lammeren FM, Mahabier C, Steenvoorde P, de Vries Reilingh TS, Wiezer RJ, de Wilt JHW, Bleichrodt RP, Rosman C. Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial. Hernia 2015; 20:535-41. [DOI: 10.1007/s10029-015-1427-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/18/2015] [Indexed: 01/01/2023]
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de Haas SA, van der Weijden P, Steenvoorde P, Joosten PH. A Case of Intrathoracic Stomach and Spleen After Aortic Repair: An Unusual Complication. J Clin Med Res 2010; 2:140-1. [PMID: 21629527 PMCID: PMC3104639 DOI: 10.4021/jocmr2010.04.293w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2010] [Indexed: 11/21/2022] Open
Abstract
A patient is described who presented with an intrathoracic stomach and spleen two weeks after aortic repair for an aortoduodenal fistula. At an urgent laparotomy the stomach was repositioned and the spleen removed. The patient recovered fully. The possible mechanism of this severe complication is discussed and relevant literature reviewed.
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Affiliation(s)
- Stephanie A.M. de Haas
- Department of Intensive Care, Rijnland Hospital Leiderdorp, The Netherlands
- Corresponding author,
| | | | - P. Steenvoorde
- Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands
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Vermeiden J, Doorn LPV, Da Costa A, Kaptein AA, Steenvoorde P. Coping Strategies Used By Patients With Chronic and/or Complex Wounds . Wounds 2009; 21:324-328. [PMID: 25902921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Objective. The aim of this study was to investigate coping strategies used by patients with chronic and/or complex wounds treated in an outpatient wound clinic. METHODS Coping strategies were assessed using the Utrecht Coping List (UCL). The Mini-Mental State Examination (MMSE) was used to assess the patient's cognitive functioning. Fifty patients were selected for this study. The wound etiologies studied were: diabetic foot ulcers, lower extremity ulcers, surgical wounds, trauma wounds, and pressure ulcers. RESULTS Scores on the coping measure for men and women differed significantly from the control groups. It was also found that each wound etiology showed a preference toward different coping strategies. Furthermore, 28% of the studied group had a lowered score on the MMSE, indicating possible cognitive impairments. CONCLUSION There might be an association between wound etiology and the coping strategy that is preferred; this knowledge could be used to guide treatment strategies used by clinicians. Further research could focus on the effects of coping strategies on wound healing rates .
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Affiliation(s)
- J Vermeiden
- Afd. Wondcentrum, Simon Smitweg, The Netherlands;
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Abstract
Full healing was achieved following the circumferential application of VAC therapy to prepare a large lower-extremity wound involving both soft-tissue injury and femoral fractures for grafting. No complications were reported.
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Steenvoorde P, van de Drift L, Corsmit OT, Neijenhuis P. Bilateral tension pneumothorax after TEM: a rare complication. Report of a case. Int J Colorectal Dis 2008; 23:723. [PMID: 18214498 DOI: 10.1007/s00384-008-0443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2008] [Indexed: 02/04/2023]
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Affiliation(s)
- P. Steenvoorde
- Department of Surgery, Rijnland Hospital, Leiderdorp, the Netherlands; Rijnland Wound Clinic, Leiderdorp, the Netherlands
| | | | - C. Naves
- Department of Surgery, Rijnland Hospital, Leiderdorp, the Netherlands
| | - J. Oskam
- Department of Surgery, Rijnland Hospital, Leiderdorp, the Netherlands; Rijnland Wound Clinic, Leiderdorp, the Netherlands
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Abstract
Surgeons at a Dutch wound clinic close open wounds with split-skin grafts. Concerns about the risk of postoperative complications in some patients led them to find an alternative option. Use of an extracellular matrix dressing was effective.
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Affiliation(s)
- M Leijnen
- Department of Surgery, Rijnland Medical Centre, Leiderdorp, The Netherlands
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Steenvoorde P, Van Doorn LP, Brehm V, Verdegaal SH, Oskam J. Use of a cadaveric donor fascia lata in a patient with an open knee joint following necrotising fasciitis. J Wound Care 2007; 16:115-7. [PMID: 17385587 DOI: 10.12968/jowc.2007.16.3.27020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P Steenvoorde
- Rijnland Wound Clinic and Department of Surgery, I Rijnland Hospital, Leiderdorp, The Netherlands.
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13
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Affiliation(s)
- P Steenvoorde
- Rijnland Wound Clinic and Department of Surgery, I Rijnland Hospital, Leiderdorp, The Netherlands.
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Abstract
Obesity is an enduring chronic disease, with multifactorial etiology. Many procedures and solutions have been proposed in the last 25 years. If patients do not meet the criteria for bariatric surgery, intragastric balloons may be used to achieve weight reduction. Contraindications to balloon therapy are a large hiatal hernia, severe esophagitis, peptic ulceration and previous gastric surgery. Although intragastric balloons are advocated as safe devices, major complications such as intestinal obstruction, gastric perforation and gastric ulceration have been described. We report a case of esophageal rupture due to insertion of an intragastric balloon for the treatment of morbid obesity, for which no contraindication existed. When abnormal pain or discomfort arises, or esophageal damage is noted after insertion of an intragastric balloon, patients must be closely monitored to diagnose a possible esophageal rupture early and thereby prevent severe complications.
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Affiliation(s)
- H W Nijhof
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
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van Doorn LP, Steenvoorde P. [Diagnostic image (291). A man with a distended abdomen]. Ned Tijdschr Geneeskd 2006; 150:2036. [PMID: 17058461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 52-year-old mentally retarded man with abdominal distension had a volvulus of the sigmoid, with a 'bird beak' sign on a plain abdominal radiograph.
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van de Minkelis JL, Steenvoorde P, Baranski AG. Liver rupture in a patient with HELLP syndrome successfully treated with extensive surgery combined with recombinant factor VIIa. Acta Chir Belg 2006; 106:602-4. [PMID: 17168279 DOI: 10.1080/00015458.2006.11679961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J L van de Minkelis
- Department of Transplantation Surgery, Leiden University Medical Centre, The Netherlands
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Abstract
BACKGROUND Necrotizing soft tissue infection (NSTI) is a disastrous infection of the subcutaneous tissue and underlying fascial layers. Even if urgent treatment is started, mortality rates are high. Due to the paucity of specific cutaneous signs, early recognition is extremely difficult. This in turn causes a delay in diagnosis and worsens prognosis. Although NSTI can develop after a wide variety of causes, specific clues such as initial gram staining and a high index of suspicion should alert the clinician to an abdominal causative agent, which alters surgical treatment strategy. If detected early, prognosis for the patient is improved. METHODS Four patients with NSTI of the thigh due to an abdominal origin are detailed regarding their clinical presentation, gram stain or culture, abdominal focus, and treatment. Based on our clinical experience and a review of the relevant literature, we address clinical challenges and controversies of importance. RESULTS Current literature on NSTI recommends prompt surgical debridement and broad-spectrum antibiotic therapy. Our cases revealed that an abdominal focus is not uncommon; however, it can be easily missed, which delays treatment. All cases demonstrated polymicrobial gram stains and cultures, which can raise suspicion of and lead to determination of an abdominal focus. CONCLUSIONS High clinical suspicion or a polymicrobial gram stain or culture should quickly lead to determination of an abdominal source. Early surgical exploration and focus treatment, together with prompt surgical debridement and broad-spectrum antibiotic therapy, could reduce mortality significantly.
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Affiliation(s)
- H W Nijhof
- Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.
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Steenvoorde P, Menon AG. [Diagnostic image (277). A woman with epigastric pain 10 years after a mastectomy]. Ned Tijdschr Geneeskd 2006; 150:1291. [PMID: 16821453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A 59-year-old woman presented with epigastric pain due to peritonitis carcinomatosa caused by breast cancer diagnosed and surgically treated 10 years earlier.
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Affiliation(s)
- P Steenvoorde
- Leids Universitair Medisch Centrum, afd. Heelkunde, Leiden.
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Jukema GN, Steenvoorde P, Wong CY, Bernards AT, van Dissel JT. [Maggot therapy for treatment of severe infections in trauma surgery: "back to the future!"]. Zentralbl Chir 2006; 131 Suppl 1:S75-8. [PMID: 16575650 DOI: 10.1055/s-2006-921510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.
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Affiliation(s)
- G N Jukema
- Department of Surgery, Section of Traumatology, Leiden University Medical Center, The Netherlands.
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Rozeboom AL, Steenvoorde P, Hartgrink HH, Jukema GN. Necrotising fasciitis of the leg following a simple pelvic fracture: case report and literature review. J Wound Care 2006; 15:117-20. [PMID: 16550665 DOI: 10.12968/jowc.2006.15.3.26875] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Necrotising fasciitis is a rare complication following pelvic fracture, but has a high mortality rate. Topical negative pressure and maggot debridement therapy can be used alongside the usual treatment of surgical debridement and antibiotic therapy.
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Affiliation(s)
- A L Rozeboom
- Department of Surgery, Leiden University Medical Centre,The Netherlands
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Abstract
OBJECTIVE Pain as a complication of maggot debridement therapy (MDT) has been a topic of some controversy. This study set out to determine pain levels in patients treated with MDT. METHOD A retrospective analysis using a visual analogue scale (VAS) was performed: 41 patients were treated with MDT for non-healing wounds (22 men and 19 women; average age: 67 years). Average wound duration was 14 months (range: two weeks to 132 months). Maggots were applied using the contained or the free-range techniques. Paracetamol (1 g three times daily) and Durogesic plaster (25 microg every three days and 50 microg the day before the maggot change) were given for pain relief in the outpatient clinic. RESULTS Diabetic patients experienced the same amount of pain before and during MDT. Eight out of 20 non-diabetic patients experienced more pain during MDT than before; the remaining non-diabetic patients had the same amount of pain before and during the therapy. The difference between diabetic and non-diabetic patients was statistically significant (p<0.05) for all applications combined. CONCLUSION In 78% of patients (29/37) pain can be adequately treated with analgesic therapy. However, if pain is unmanageable in the outpatient department, we believe that options include hospital admission, using the contained method of application or, in the worst case scenario, cessation of treatment. A standardised but individually tailored pain management protocol is mandatory.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
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Steenvoorde P, van Ingen JR. [Diagnosis image (255). A woman with a painful hand after plaster treatment]. Ned Tijdschr Geneeskd 2005; 149:2969. [PMID: 16425849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 22-year-old woman was treated with a plaster cast for a fifth metacarpal fracture of the left hand and later developed a complex regional pain syndrome.
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Rozeboom AL, Havekes B, Steenvoorde P, Arbous MS, Elzo Kraemer CV, van de Velde CJH. [The abdominal compartment syndrome]. Ned Tijdschr Geneeskd 2005; 149:1309-13. [PMID: 16008031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement.
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Affiliation(s)
- A L Rozeboom
- Afd. Heelkunde, Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden
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Abstract
Wound infection after breast surgery is not uncommon and is not always simple to treat. This paper presents the case of a patient in whom the wound was successfully treated with larval debridement therapy after other methods failed.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
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Abstract
In the literature maggot therapy is discussed as a promising and potent form of debridement therapy. The number of maggots needed to debride a wound is estimated at 10 per cm2, and more in case of a higher percentage of necrosis or slough. In the authors' hospital, from March 1999 to May 2002, 16 patients were successfully treated with maggot therapy. The average maggot treatment time was 27 days, with an average of seven maggot changes. Most patients were treated for osteomyelitis, with trauma being the leading aetiological factor. In accordance with in-vitro findings, maggot therapy was found to be more effective in gram-positive infected wounds. Gram-negative bacteria are cultured more often after maggot treatment than before it (p=0.001). The opposite effect was found for gram-positive infected wounds (non-significant p=0.07). In vivo maggots seem to be less effective against gram-negative infected wounds. The authors believe that a higher number of maggots is needed not only for a larger wound or a wound with a higher percentage covered with slough, but also for a wound infected with gram-negative bacteria.
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Affiliation(s)
- P Steenvoorde
- Section of Traumatology, Department of Surgery, Leiden University Medical Center, The Netherlands.
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Steenvoorde P, Oskam J. [Diagnostic image (211). A man with a skin wound after a dog bite]. Ned Tijdschr Geneeskd 2004; 148:2071. [PMID: 15532329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 34-year-old man sought medical advice for a dog bite on his left lower leg. The wound progressed after split skin transplantation. It was proved to be pyoderma gangrenosum associated with colitis ulcerosa and responded well to oral prednisone therapy.
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Affiliation(s)
- P Steenvoorde
- Leids Universitair Medisch Centrum, afd. Heelkunde, Postbus 9600, 2300 RC Leiden.
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de Roo RA, van Breda Vriesman AC, Steenvoorde P. [Diagnostic image (186) A man with abdominal pain in the left upper quadrant. Acute appendicitis with malrotation of the colon]. Ned Tijdschr Geneeskd 2004; 148:825. [PMID: 15141648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 54-year-old man presented with abdominal pain in the left upper quadrant due to acute appendicitis with a malrotation of the colon.
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Affiliation(s)
- R A de Roo
- Afd. Chirurgie, Rijnland Ziekenhuis, Postbus 4220, 2350 CC Leiderdorp.
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Steenvoorde P, Vogelaar FJ, Oskam J, Tollenaar RA. [Giant diverticulum of the sigmoid]. Ned Tijdschr Geneeskd 2004; 148:855; author reply 855. [PMID: 15141655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Steenvoorde P, van Engeland A, Bonsing B, da Costa SA, Oskam J. Combining topical negative pressure and a Bogota bag for managing a difficult laparostomy. J Wound Care 2004; 13:142-3. [PMID: 15114824 DOI: 10.12968/jowc.2004.13.4.26605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A patient with a severe intra-abdominal infection required a laparostomy. A Bogota bag was combined with topical negative pressure therapy, saving nursing time and enabling successful management of wound fluid.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
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Vogelaar FJ, Molenaar IQ, Adhin S, Steenvoorde P. Invagination of the appendix: diagnostic laparoscopy? Dig Dis Sci 2004; 49:351-2. [PMID: 15104383 DOI: 10.1023/b:ddas.0000017464.50532.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
OBJECTIVE This study investigated retrospectively whether three laboratory investigations--testing for leucocyte levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)--can be used to guide the decision of when to discontinue larval therapy. METHOD Between 1999 and 2002 we administered larval therapy to 16 inpatients. In all cases the decision to discontinue therapy was a clinical one made by the surgeon who headed the trauma department. We retrospectively analysed laboratory investigations, testing for leucocyte levels, CRP and ESR, on the first and last days of therapy to ascertain if the results could have guided this decision. RESULTS The median leucocyte count on the first day of larval therapy was 10.5 (x 10e9/L) compared with 8.4 (x 10e9/L) on the last day (Friedman test: p < 0.05). CRP and ESR showed a non-significant tendency towards lower values. CONCLUSION Although the methodological limitations of this open-label non-comparative cohort study preclude a definite conclusion, we believe that laboratory investigations, particularly leucocyte count, can guide the decision of when to discontinue larval therapy. However, this objective parameter cannot replace clinical judgement.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
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Abstract
BACKGROUND A rare complication of diverticulosis of the colon is giant colonic diverticula (GCD). The condition was first described in English literature in 1953. METHODS A Medline search was undertaken for English, French and German language articles on 'giant colonic diverticula'. RESULTS A total of 135 patients were identified, presenting with a total of 155 GCD. With a complication rate of 28% and an operative mortality of 5%, GCD seems to have a high clinical significance. Radiological examination of choice seems to be plain abdominal X-ray and CT examination, barium enema carries the risk of perforation of the diverticulum, and should not be performed. CONCLUSIONS There are different therapeutic options, in our opinion diverticulectomy alone is not the treatment of choice. Because of the possibility of recurrence and oncological reasons, colectomy seems to be the best treatment. The creation of a protecting colostomy depends on other operative findings.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
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Abstract
The authors describe a 14-year-old boy who presented at the emergency department after he deliberately inserted a soda can in his rectum 48 hours before presentation. The authors were able to remove the foreign body in the operating room by squeezing and twisting the upper round of the empty soda can, in this way changing the original cylinder shape into a conus-shape. Retained foreign bodies in the rectum of children are rare. The authors report our case and discuss the relevant literature.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Leiden University Medical Centre, Leidon, The Netherlands
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Affiliation(s)
- P Steenvoorde
- Rijnland Hospital, Department of Surgery, Leiderdorp, Netherlands
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Abstract
BACKGROUND In a period of 5 years, 2 patients with enterolith ileus, caused by jejunal diverticulosis, were treated in our hospital. In order to learn more about treatment options, the literature was reviewed. METHODS The case history of the 2 patients is described. Relevant articles were identified using Medline and PubMed. Data regarding patient gender, age, operative findings, therapeutic measures and outcome were collected. RESULTS Including patients reported in the literature, 34 cases of intestinal obstruction due to enteroliths expelled from jejunal diverticula were identified. A distinction is made between complicated and uncomplicated enterolith ileus. If there are signs of bowel ischemia, other (unborn) enteroliths, inflammation of the bowel or if there are signs of a (sealed) perforation, the case is considered a complicated enterolith ileus. If none of these signs are present, uncomplicated enterolith ileus is present. In uncomplicated enterolith ileus (21 patients), more often milking and crushing or enterotomy was performed. In complicated enterolith ileus (13 patients), more often a segmental resection of the involved jejunum was performed (p < 0.01). CONCLUSION Small bowel obstruction due to enteroliths expelled from jejunal diverticula is a rare condition. Relevant literature is only available in the form of case reports. On the basis of the presented patients and patients reported in the literature, a justifiable therapeutic strategy is presented. The least invasive step in the therapeutic approach is to crush and milk the obstructing enterolith down to the colon. Laparoscopic crushing and milking of the enterolith is described. If this fails an enterotomy could be tried, if possible proximal or distal from the obstruction site, in order to make an incision in a less edematous area. If the first two strategies fail, or if complicated enterolith ileus is present, resection of the involved jejunal segment could be considered.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Spaarne Hospital, Haarlem, The Netherlands.
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Abstract
Gastrointestinal intussusception is an uncommon condition caused by a pendunculated, gastric tumor being forced through the pyloric sphincter and into the duodenum. An extremely rare case of gastrojejunal intussusception caused by a giant gastric lipoma is described in this article. The patient presented with anemia and weight loss. Initial gastroduodenal endoscopy failed to establish the diagnosis but abdominal ultrasound and computed tomography revealed signs of intussusception possibly associated with a lipoma of the small bowel. At laparotomy a pendunculated, submucosal, gastric lipoma, measuring 10 x 5 cm was found to have been intussuscepted into the jejunum. It was reduced and removed through a gastrotomy. Recovery was uneventful.
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Affiliation(s)
- C M Mouës
- Department of Surgery, Spaarne Hospital, Haarlem, The Netherlands.
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Jukema GN, Menon AG, Bernards AT, Steenvoorde P, Taheri Rastegar A, van Dissel JT. Amputation-sparing treatment by nature: "surgical" maggots revisited. Clin Infect Dis 2002; 35:1566-71. [PMID: 12471580 DOI: 10.1086/344904] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2002] [Accepted: 09/17/2002] [Indexed: 11/04/2022] Open
Abstract
Maggots were used as adjunct treatment for infected wounds that showed no response to the classical approach of wound debridement and antibiotic therapy. We summarize findings for 11 patients with necrotic wounds who received treatment with "surgical" maggots (100-2900 applied in 3-10 changes of dressing) for 11-34 days, which apparently aided in tissue remodeling and cure, and describe 2 typical patients in detail.
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Affiliation(s)
- G N Jukema
- Section of Traumatology, Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
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Steenvoorde P, Pauwels EK, Harding LK, Bourguignon M, Marière B, Broerse JJ. Diagnostic nuclear medicine and risk for the fetus. Eur J Nucl Med 1998; 25:193-9. [PMID: 9473270 DOI: 10.1007/s002590050215] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The possible detrimental effects on the developing embryo subsequent to irradiation are discussed. The doses to the embryo or fetus encountered for the most common procedures in diagnostic nuclear medicine are evaluated with respect to the threshold doses and the risks per cGy. The threshold dose for fatal and non-fatal malformations or other defects is, at the lowest estimate, 5-10 cGy. The dose which the embryo or fetus receives from diagnostic nuclear medicine is below 1 cGy. For the induction of fatal cancer and for genetic defects no threshold dose is assumed. The risk for the induction of cancer is 0.03%-0.05% per cGy. The risk for the induction of genetic defects is even lower (0.024%-0.099% per cGy). It is concluded that for common diagnostic nuclear medicine procedures the risk of detrimental effects on the embryo or fetus due to radiation is negligible. On the basis of present knowledge there are no radiation safety indications for abortus provocatus as a consequence of a diagnostic nuclear medicine study.
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Affiliation(s)
- P Steenvoorde
- Department of Radiology (Division of Nuclear Medicine), Leiden University Medical Centre, Leiden, The Netherlands
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